Page 25 - The clinical aspects and management of chronic migraine Judith Anne Pijpers

of migraine chronification and reversibility by studying cutaneous allodynia characteristics related to response to therapy (chapter 6).
In chapter 2 we elaborate on risk factors for migraine chronification, describing symptom patterns of affective disorders in participants with migraine, current or past affective disorders and healthy controls. Moreover the possible association between these symptom patterns, allodynia and migraine attack frequency is studied. Chapter 3 describes a withdrawal study, relating to both medication overuse as a risk factor for headache chronification, and its treatment. In a controlled manner, the effect of the support by a headache nurse during withdrawal therapy is studied. Chapters 4 and 5 are randomised controlled trials including participants with chronic migraine patients with medication overuse, both using unique designs to ensure blinding of patients. Chapter 4 studies the effect of botulinum toxin A versus placebo concomitant to withdrawal therapy, chapter 5 describes the effect of a behavioural therapy by a headache nurse concomitant to withdrawal therapy.
Chapter 6 studies the predictive value of cutaneous allodynia for response to withdrawal therapy. Furthermore it provides some insight into the pathophysiology of migraine chronification and reversibility, by differentiating different subtypes of cutaneous allodynia.
Finally, chapter 7 provides a summary, general discussion and future perspectives on the different aspects and management of chronic migraine.
1
General introduction
23